MEDICARE: NEUROSPINE SPECIALISTS OF ARIZONA PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207T00000X	Neurological Surgery Physician

General Provider Information

NPI Number	:	1699231910
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEUROSPINE SPECIALISTS OF ARIZONA PLLC

Provider Business Mailing Address
First Line	:	2222 E HIGHLAND AVE STE 222
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-4872
Country	:	US
Telephone Number	:	602-975-0123
Fax Number	:	623-900-7937

Provider Business Practice Location Address
First Line	:	2222 E HIGHLAND AVE STE 222
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-4872
Country	:	US
Telephone Number	:	602-975-0123
Fax Number	:	623-900-7937

Authorized Official
Title or Position	:	MEMBER
Name	:	ABHISHIEK SHARMA
Credential	:	MD
Telephone Number	:	602-975-0123

Provider Enumeration Date	:	02/11/2019
Last Update Date	:	02/11/2019

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